Abstract:Abstract:Objective：To study a method for the detection of peritoneal micrometastasis of gastric cancer (GC) and its significance.
Methods ：During operation,peritoneal washings were collected before tumor resection in patients with various stages of gastric cancer, and the tumor cells in the peritoneal lavage were enriched, collected and analyzed using magnetic activated cell sorting (MACS) technique. The cells were labeled by anti-cytokeratin(CK)antibody with magntic microbeads and passed through magnetic columns. The CK+epithelial cells were quantified by flow cytometry and the differences of amount of CK+epithelial cells collected before and after magentic enrichment in the gastric cancer group and the control group, and between different stages of gastric cancer were compared. There were 50 cases in gastric cancer group and 10 cases of gastric leiomyoma in the control group.
Results：CK+CD45- cells were rarely detected in the samples without MACS; in the samples treated by MACS, the concentrations of CK+CD45- cells were significantly higher in GC group than in control group（41/50vs1/10，P<0.001）, and lower in pTNM stage Ⅰ-Ⅱ group than in stage Ⅲ-Ⅳ group.( 0.67% vs 3.42%, P<0.001)
Conclusions：MACS can effectively enrich epithelial tumor cells in peritoneal lavage, increase the detection rate of epithelial-derived cells, and close relationships were found between CK+CD45- cell concentrations with free tumor cells and clinicopathologic stages. The technique could become a valuable tool to evaluate the risk of cancer metastasis and prognosis and to guide therapy.

Abstract:Abstract:Objective：To discuss the effect of intra-operative and post-operative hyperthermic intraperitoneal lavage chemotherapy for Ⅲb and IV gastric cancer on post-operative peritoneal metastasis and survival rate.
Methods ：The clinical data of 31 cases of gastric cancer (control group) who underwent operation only and 50 cases (chemotherapy group) who receved operation combined with intra-operative and post-operative hyperthermic intra-peritoneal lavage chemotherapy were comparatively studied.
Results：The survival rate of control group after 2 years and 3 years was lower than that of the chemotherapy group, and the intraperitoneal recurrence rate of control group after 2 years and 3 years was higher than that of chemotherapy group.
Conclusions： Intra-operative and post-operative hyperthermic intraperitoneal lavage chemotherapy for gastric cancer has important significance in prevention and treatment of peritoneal metastasis and can improve survival rate.

Abstract:Abstract:Objective：To evaluate the therapeutic effect of neoadjavunt chemotherapy for gastric carcinoma.
Methods ：Forty-eight gastric carcinoma patients(stage IIIb and IV) were selected. Pre-operatively, they received a two-week regimen of oxaliplatin,5-Fu and CF. After 2-3 cycles treatment, CT and gastroscopy were used to determine resectability and then operation was performed.
Results：The total efficiency of neoadjuvant chemotherapy was 58.4%， while it was 64.1% for stage IIIb and 22.2% for stage IV cases. In 39 stage III patients，the radical resection rate was71.8%。In 9 stage IV patients，2 were received palliative resection and one underwent simple abdominal exploration.
Conclusions：Neoadjuvant chemotherapy could effectively increase the radical resection rate of stage III gastric carcinoma patients, but the therapeutic effect was not significant for stage IV patients.

Abstract:Abstract:Objective：To analyze the clinical diagnosis and treatment of recurrent cancer in gastric remnant.
Methods ：Clinical data of 48 patients who underwent surgical re-operation because of recurrent carcinoma within gastric remnant after radical resection of gastric cancer were analyzed retrospectively.
Results：All 48 cases were recurrent cancer in gastric stump. The time of recurrence was 6-36 months after first radical resection. After reoperation, the mean survival time of 28 patients (58.3%) who underwent radical resection was 40 months; the mean survival time of 20 patients (41.7%) who received palliative treatment was 14.8 months (P<0.01) . The mean survival time of all patients was 30.6 months and the median survival time was 28.0 months. There was significantly different outcome between the groups classified by pathologic stages, whether or not there was peritoneal seeding and performance of radical resection.
Conclusions：The clinical stages, whether or not there was peritoneal seeding and performance of radical resection are the critical prognotic factors for recurrent carcinoma within gastric remnant. Radical resection is an effective way to treat recurrent carcinoma within gastric remnant.

Abstract:Abstract:Objective：To introduce a new anus preserving operation for low rectal cancer-ultralow anterior resection and colorectal/coloanal anastomosis by using supporting-bundling up method.
Methods：The clinical data of 310 patients who underwent anus preserving operation by supporting-bundling up method for low rectal cancer were retrospectively reviewed.
Results：The mean distance of tumor from the anal verge was 4.7±1.2cm; the TNM stage was stage Ⅰin 40 cases, stage Ⅱ30 cases, stage Ⅲ109 cases and stage Ⅳ 31 cases. the mean distance of the anastomosis from the anal verge was 2cm(1-4cm). the occurrence rate of postoperative anastomosis leak was 2.3%, the rate of excellent anal sphincter control was 82.25%. The 5-year local recurcence rate was 5.8%.
Conclusions：Ultralow anterior resection and colorectal/coloanal anastomosis by supporting-bundling up method may be one of the best anus preserving operations for low rectal cancer. It is a safe and feasible operation, and the long-term outcome is excellent.

Abstract:Abstract:Objective：To investigate the outcome of low anterior resection of rectal cancer with double stapling technique.
Methods ：A retrospective analysis of clinical records of 78 rectal cancer patients who had anal preservation operation using double stapling technique was performed.
Results：In all of the cases, the rectal closing and anastomosis were satisfactorily completed. All the resection margins were negative for tumor infiltration. There was no operative mortality or anastomosis leakage. Seventy-three (93.6%) cases were followed up for 9-65 months, pelvic recurrence occurred in 2 cases (2.7%), multiple metastasis of peritoneal cavity occurred in 1 case(1.4%), liver metastasis was found in 7 cases (9.6%), one patient suffered from local recurrence and Miles operation was performed 11 months later.
Conclusions：Double stapling technique can provide more chances for sphincter preservation operation in patients with lower rectal cancer. If the technique is properly used, it also may effectively reduce the rate of anastomosis leakage and other complications.

Abstract:Abstract:Objective：To study the value of protective ileostomy in preventing anastomotic leakage following ultralow anterior resection for rectal cancer.
Methods ：The clinical records of 98 patients with rectal cancer electivly undergoing ultralow anterior resection were retrospectively analyzed. A randomized comparative study between ileostomy group (45 patients) and without ileostomy group (53 patients) was conducted.
Results：An anastomotic leakage was diagnosed in 11 patients (20.8%) without protective ileostomy and in only 1 patients (2.2%) with ileostomy.
Conclusions：The elective use of a protective ileostomy for ultralow anterior resection can effectively reduce the rate of anastomotic leakage.

Abstract:Abstract:Objective：To evaluate the treatment of colorectal carcinoma with acute colonic obstruction in the elderly.
Methods ：The clinical data of 116 elderly patients undergoing emergency operation for acute colonic obstruction due to colorectal carcinoma were analyzed retrospectively. The patients were treated in recent 5 years. There were 39 elderly patients with right-side colonic lesion, 64 cases with left-side colonic lesion and 13 elderly patients with rectal lesion. All patients received emergency operation. One stage tumor resection and anastomosis was performed in 39 cases with right-side colonic lesion and in 62 cases with left-side colonic lesion, Hartmann operation in 9 cases, Dixon operation in 4 cases and proximal colostomy in 2 cases.
Results：Postoperative complications occurred in 17 cases (14.7%), including wound infection, intraperitoneal sepsis and intestinal fistula. One hundred and fifteen cases recovered (99.1%), but there was one perioperative death.
Conclusions：Under certain conditions, one stage tumor resection is feasible and safe for acute colonic obstruction due to colorectal carcinoma in elderly patients.

Abstract:Abstract:Objective：To screen the associated proteins of clinical stage of colorectal carcinoma(CRC) in order to provide the basis of molecular biological stages and outcome prediction of CRC.
Methods ：Total protein from colorectal carcinoma tissues were extracted, differential proteome profiles were established and analysized by means of immobilized pH gradient-based two-dimesional polyacrylamide gel electrophoresis(2D-PAGE) and matrix-assisted laser desorption/ionization time of flight mass spectrometry(MALDI-TOF-MS). Immunohistochemical method was used to assess the results mentioned above.
Results：Well-resolved, reproducible 2-DE profiles of human colorectal carcinoma tissues were obtained. Avarage protein dots were 970±41，980±32，1010±43，1240±34 in stageⅠ, stageⅡ, stageⅢ, stageⅣ, respectively; compared to stageⅠ, differential expressed protein dots was 52.00±12 in stageⅡ; 42.00±11 in stageⅢ; 72.00±15 in stageⅣ ;30 differentail expressing proteins were analysized by mass spectrometry and bioinformation, part of them were well characterized . Three proteins (Annexin Ⅱ,Annexin Ⅳ and HSP27) were overexpressed in stageⅡ, stageⅢ, stageⅣ, and Liver fatty acid-binding protein(LFABP) was only overexpressed in stageⅣ. Resullts of immunohistochemical assay for AnnexinⅡ and LFABP were consistant with proteomic results.
Conclusions：Differentail expressed proteins exist in different clinical stage of CRC, which would be as biomarkers for diagnosis and prediction of prognosis of CRC.

Abstract:Abstract:Objective： To investigate immunoliposomal docetaxel in combination with radiation on the expression of apoptosis-related proteins in LoVo cell line.
Methods ：Immunoliposomal docetaxel was prepared by coupled CEA antibody. LoVo cells were treated with immunoliposomal docetaxel and irradiation (group A), or with liposomal docetaxel and irradiation (group B), or irradiation alone (group C). The apoptosis index (AI) was evaluated by TUNEL method. The expressions of proteins p53, Bcl-2 and Bax were detected by flow cytometry. Fas、FasL and survivin proteins were detected by immunohistochemical staining and were quantified using semi-quantitative analysis by image analysis system.
Results：AI in group A (43.6%) was Significantly higher than that in group B (17.7 %) and group C (16.8%)(P<0.01).but no significant difference between group B and group C (P>0.05). Bax, Fas and FasL expression in group A were significantly higher than those in group B, but survivin expression in group A was lower than thatin group B (P<0.01).
Conclusions：Different pathways are involved in promotion of apoptosis in cancer cells that undergo docetaxel treatment, and decetaxel can enhance LoVo cells radiosensitization.

Abstract:Abstract:Objective：To investigate the expression of focal adhesion kinase in peripheral blood of colorectal cancer and its clinical significance.
Methods ：Focal adhesion kinase in peripheral blood was determined with flow cytometry in 40 cases of colorectal cancer and 20 cases of control group.
Results：The positive rate of focal adhesion kinase in colorectal cancer group was 60.0% and in control group was 25.0% ,respectively(P<0.05). Mean value of focal adhesion kinase expression was high in cases with cancers and was related to clinical stage, degree of histological differentiation, and lymphatic metastasis.
Conclusions：Focal adhesion kinase expression in human peripheral blood lymphocytes may be related with the tumor load statue, and can be used as an index for surveillance and screening of colorectal cancer high risk population.

Abstract:Abstract:Objective：To detect -174G→C polymorphism of IL-6 gene promoter in patients with colorectal cancer.
Methods ：-174G→C polymorphism of IL-6 gene promoter was detected by PCR-RFLP in 49 patients with colorectal cancer.
Results：-174G→C polymorphism of IL-6 gene promoter in all the 46 patients with colorectal cancer was -174G/G genotype.
Conclusions：-174G→C polymorphism of IL-6 gene promoter was not found in 49 patients with colorectal cancer.

Abstract:Abstract:Objective：To investigate the inhibitory effect of combined treatment of allicin with paclitaxel on gastric cancer cell lines and promotion of apoptosis and its possible mechanism.
Methods ：After treatment with allicin or paclitaxel alone or in combination ,the MGC-803 gastric cancer cells growth was determined by MTT assay. Flow cyctometry was used to determine apoptosis of gastric cells.The expression of mRNA of bcl-2 and bax genes was detected by RT-PCR, and the expressions of protein bcl-2 and bax were detected by Western blotting.
Results：Both allcin and paclitaxel alone could inhibit the growth of MGC-803 gastric cancer cells in a dose dependent manner . Combined treatment of allcin 9ug/mL with paclitaxel (1-16μg/mL) resulted in a synergistic effect of inhibiting cell growth. After incubation with allcin 15μg/mL,paclitaxel 12μg/mL alone and in combination ,the apoptosis rate was 10.7%,30.4%,84.7%, respectively (P< 0.01).Treatment with combination of the two drugs enhanced expression of pro-apoptotic gene bax and reduced expression of the anti-apoptotic gene bcl-2, but there was no effect when the drugs were used singly.
Conclusions：The combined treatment of allicin with paclitaxel has a synergistic inhibiting effect on growth of gastric cancer cell lines, and induction of apoptosis by enhancing bax expression and decreasing bcl-2 expression may be the related mechanism.

Abstract:Abstract:Objective：To investigate the effect of HSP 70 in the proliferation and apoptosis of esophageal cancer cell line Eca-109 by inhibiting HSP 70 expression with HSP 70 antisense oligonucleotides.
Methods ：After Eca-109 cells were transfected with HSP 70 antisense oligonucleotides, analysis of HSPEO mRNA and protein expression by RT-PCR and western blotting were made respectively, the proliferation, induction of apoptosis and cell cycle were detected.
Results：After transfection with HSP 70 antisense oligonucleotides, the expression of HSP 70 was partially blocked, the proliferation of Eca-109 cells was apparently inhibited，and its inhibitory rate was increased to 25.5 % at 48h and 35.4% at 72h respectively. Apoptosis rate induced by HSP 70 antisense oligonucleotides was obviously higher than that by HSP 70 sense oligonucleotides or untransfected group (P<0.05).
Conclusions：HSP 70 antisense oligonucleotides could not only inhibit the proliferation, but also induce the apoptosis of Eca-109 cells.

Abstract:Abstract:Objective：To investigate the therapeutic effects and mechanism of dbcAMP-Ca in treatment of rats with gastric stress ulcers induced by internal capsule hemorrhage.
Methods ： The levels of pituitary adenylate cyclase activiting poly-peptide (PACAP) in plasma and stomach tissues of rats with cerebral hemorrhage and treated by dbcAMP-Ca after 24h were determined by RIA.
Results：The level of PACAP in plasma of cerebral hemorrhage group was significantly higher than that in control group(P＜0.01), and the level of PACAP in stomach tissues of cerebral hemorrhage group was lower than that in control group(P＜0.01). The level of PACAP in plasma of treatment group was significantly lower than that in cerebral hemorrhage group(P＜0.01).and the level of PACAP in stomach tissues of treatment group was higher than that in cerebral hemorrhage group (P＜0.01).
Conclusions：PACAP may play some important role in gastric stress ulcers induced by internal capsule hemorrhage, and dbcAMP-Ca has an important effect in treatment of rats with gastric stress ulcers induced by internal capsule hemorrhage.

Abstract:Abstract:Objective： To explore the causes of upper gastrointestinal rebleeding after devascularization operation for portal hypertension and the therapeutic effect of shunt operation.
Methods ：The clinical data of 56 cases of upper gastrointestinal rebleeding after devascularization operation for portal hypertension in our hospital from 1996 to 2006 were retrospectively analyzed. Shunt operation was done in 54 ceses including emergency operation shunt in 5 cases, and elective operation in 49 cases. C-type Mesocaval shunt was done in 45 cases, inferior mesenteric vein-cava shunt in 4 cases， H-type and portacaval in 5 cases.
Results：Chylorrhea occurred in 13 cases after operation and all recovered; hepatic encephalopathy occurred in 5 cases, and 4 cases recovered, 1 died; and 1 case died of liver function failure on the third day after operation. Fifty-two cases were followed-up from 6 months to 9 years, and none had recurrence of upper gastrointestinal bleeding, but 7 died (2 cases died of primary hepatic carcinoma, 3 cases died of liver function failure and hepatic encephalopathy, and 2 cases died of non-correlated disease).
Conclusions：Patients with upper gastrointestinal rebleeding after devascularization operation for portal hypertension should undergo non-operative treatment at first, and elective surgery is done later. If aggressive non-operative treatment for 48h is not successful,then emergency operation should be performed. In elective cases, the operation of first choice is mesocaval interposition synthetic graft shunt, which is particularly applicable in patients with portal vein thrombosis or portal hypertensive gastropathy.

Abstract:Abstract:Objective：To explore the treatment efficacy of combined esophageal transection and anastomosis with stapler and portoazygous devascularization (P-AD) in treatment of ruptured osophagogastric varlces and bleeding.
Methods ：One hundred and tweenty patients with portal hypertension and ruptured esophagogastric varices with massive hemorrhage who treated in our hospital from Mar 1998 to Dec 2001 were divided into two groups randomly. Each group had 60 patients. The patients in the combined devascularization group were operated by P-AD and transabdominal esophageal transection and reanastomosis with stapler; and the patents in the control group were operated by P-AD only. The short-term complications and long-term follow-up results were observed and compared.
Results：The incidence rate of postoperative complications showed no significant difference between the two groups.(P>0.05); the disappearance rate of varices of fundus of stomach and esophagus in the combined devascularization group was higher than that in control group(P<0.01). The re-bleeding rate in the combined devascularization group was less than that in control group (P<0.05). Liver function of the patients in the two groups improved post-operatively, and no significant difference was found between the two groups (P>0.05). The long-term （fourth to seventh year）survived rate of the combined devascularization group was higher than that of control group (98.3% in the combined devascularization group, 90.0% in control group) (P<0.05).
Conclusions：The combined devascularization operation has more effective in treating esophagogastric varices, and can reduce the rate of rebleeding, improve the treatment effect of P-AD.

Abstract:Abstract:Objective：To establish a prediction model of distant metastasis in early breast cancer by using conventional clinical and pathologic factors so that patients with early breast cancer might be classified as high and low risk groups and individualized therapy could be guided by it.
Methods ： Risk factors related to the status of metastasis in early breast cancer were screened using multifactorial logistic regression. On this basis, the model for predicting distant metastasis in early breast cancer was established and its effects were observed.
Results：Multifactorial logistic regression analysis showed that the number of metastasic axillary lymph nodes, diameter of primary tumor, and level of C-erb-B2 were chosen from 12 risk factors as the modeling factors. Depending on these factors, we established the prediction model. Its accuracy rate for retrospective prediction and for prospective prediction were 79.3％ and 69.2％, respectively.
Conclusions：The risk of distant metastasis in early breast cancer can be predicted from the predicting model and these patients could be divided into two subgroups—high risk group and low risk group. This model might provide certain evidence for individualized therapy in postoperative breast cancer patients.